How To Identify And Correct Nutrient Deficiencies

Coming up on this episode of the Doctor's Pharmacy.

The majority of Americans are deficient in not just one essential nutrient, but several.

Hi, Doctor's Pharmacy listeners, it's Dr. Mark here. If you've been following me, you know that I'm obsessed with understanding the latest research on longevity and how we can apply it to our daily lives. So I wrote a book about it. Think of it as a roadmap to optimal aging. It's called Young Forever, and it comes out February 21st, 2023. It's never too early or too late to take control of your health. And this book will show you how. Visit youngforeverbook.com to learn more and pre-order now. If you've been following me for a while, you know that I often talk about how eating organ meats is so good for your health. Now, I know it can be hard to work them into your diet, but when we don't eat things like liver, kidney, and heart regularly, we're missing out on wonderful sources of essential nutrients. Organ meats are nature's multivitamins and the richest sources of natural vitamin A, B vitamins, and minerals that we have. But liver isn't everyone's first choice for a delicious meal, which is why my friends at Paleo Valley created their grass-fed organ complex supplement. Paleo Valley grass-fed organ complex contains three different organs from healthy grass-fed pasture raised cows. So you're getting a wide array of nutrients and each ingredient is sourced from a family run farm in the US. It's then gently freeze dried in order to preserve as many of the nutrients as possible. The end result is an odorless, tasteless, burpless supplement that offers all the benefits of organ meats in an easy to swallow capsule form. If you're struggling with brain fog, low energy levels, or if you just want to optimize your health and vitality, try Paleo Valley Grass Fed Organ Complex. And right now, Paleo Valley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hymen to check out all their clean Paleo products and take advantage of this deal. I'm all about streamlining my daily health routine to be as powerful and yet simple as possible. And that's why I love AG1 from Athletic Greens, because when it comes to my health, I want it all. I want my gut to function great, my brain to feel sharp, my immune system to be strong, my body to feel energized and able. And being in my line of work, I know that means I need optimal levels of nutrients, which is one scoop of AG1. I get 75 high quality vitamins, minerals, whole food source superfoods, probiotics and adaptogens to support my entire body. Even with a really healthy diet, it's hard to hit the mark for all our nutrient needs. So I feel better knowing that I have some extra help from AG1. Unlike other supplements and powders out there, AG1 is third party tested and made without GMOs, nasty chemicals or artificial anything, and it tastes great, kind of like a tropical green drink. I like it on its own mixed with water, but it also works really well in most smoothies. If you're curious about trying AG1 from Athletic Greens for yourself right now, they're offering my community 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com/ / hyman. Again, that's athleticgreens.com/hyman to take ownership over your health and pick up the ultimate daily nutritional insurance. Now let's get back to this week's episode of the Doctor's Pharmacy.

Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. We aren't obtaining the same amount of nutrients from our food as our ancestors did, nor are we absorbing all of the nutrients that we used to from the foods we eat. That means even for those of us who are focused on a whole foods diet, we may not be hitting the mark for vital nutrients to optimize our health, leaving us deficient in many important nutrients that are required for a healthy body. In today's episode, we feature three conversations from the Doctor's Pharmacy on widespread nutritional deficiencies and how to address them. Dr. Hyman speaks with Chris Kresser on why so Many People Are Nutrient Deficient, with Drew Prohovit on All the Important Effects of Nutrients in the Body, and with Dr. Elizabeth Boehm on how to look for nutritional deficiencies and why magnesium deficiencies is one of the most common.

Let's jump in. Can you just talk about the widespread nature of nutritional deficiencies, what we know about them and what they are, what.

Are the most common ones? Absolutely. And that's what opened my eyes to this as well. You know, 15 years of treating patients and every patient that walks through the door gets a full nutrient analysis. And I can probably count on one hand the number of patients that had adequate levels of all all nutrients in all of those 15 years, which is really shocking for the same reason. I have highly motivated, educated patients who are way far above the norm in terms of the attention that they're paying to this, and they were still not getting enough and it was contributing to all of their symptoms. Everything from minor symptoms like fatigue and poor quality sleep and slight mood disturbances to full-on disease, you know, autoimmune disease and gastrointestinal issues, thyroid problems, Etc. I know you've seen the same thing. So, you know, let's just kind of zoom out and see, like, how do we even know how much nutrients that we need to thrive? Well, the answer is we don't have great data on that yet because most of the scales, nutrient density scales and standards for how much we should get, like the recommended dietary allowance or RDA. The RDA was designed in World War II when they were trying to figure out rations for soldiers. And that's certainly the question they were asking there was certainly not, how can we optimize these soldiers' health? They were asking, how can we keep them alive during wartime? How can we make sure they don't develop scurvy and rickets and these diseases of malnutrition? And so that's one problem. The standard that we're using is really only designed to prevent serious problems. It's not designed for optimal health. Even within that standard though, they often haven't been updated for 25, 30 years plus. A great example is magnesium. So the RDA for magnesium was last updated in 1997. And RDAs are based on body weight. So, if there's been a change in body weight over a given period of time, the RDA should be updated and go up, but it hasn't. So in 1997, the average body weight for a female was about 135 pounds and the average weight for male was about 166 pounds and the RDA was 420 milligrams per day for men. and 320 for women. Now today though, the average weight of a woman is 170 pounds and the average weight of a man is 196 pounds. And when researchers recalculated the RDA for magnesium based on this, it went up to 650 for men and 530 for women. And the average intake is only about 340 grams a day. in this country. So that tells us most people are getting 200 to 300 milligrams per day less magnesium than they need. But if you were to just go on the web and search for the RDA for magnesium, it's still 420 for men and 320 for women. It's, you know, for 25 years ago. So I think we're dramatically underestimating the rates of nutrient deficiency for that reason. But even with all of these caveats, the latest Nurses Health Data show that the majority of Americans are deficient in not just one essential nutrient, but several. So I'll give you some stats here. 100% don't get enough potassium. 94% don't get enough vitamin D. 92% don't get enough choline. 89% don't get enough vitamin E. 67% don't get enough vitamin K. 52% don't get enough magnesium, but as I just said, that's actually probably closer to 100%. 44% calcium, 43% vitamin A. I could go on, but these statistics are shocking because they show that most people are deficient in most nutrients, full stop.

So how do we measure these? Because, you know, when you go to the doctor, they don't go, oh, wow, we just checked your nutrient levels and they're all deficient. In functional medicine, we have ways of testing them, but what are the most important diagnostic test for nutrient deficiency that people should be focused on.

Yeah.

What are the most common ones? I mean, you mentioned a lot of them. What are the things we actually want to test for? And how do we test for those?

So this is one of the biggest challenges, unfortunately, and you know this, Mark, from your practice, where it's very difficult. It would. What would be perfect is if there was, like, a single panel you could run with a single body fluid that would accurately test all nutrients. That's like the Holy Grail. I I wish. I, you know, if there's one thing I've always wanted as a clinician that I never, that I've never had, it's that.

Right. Yeah.

But, but you know that if with each different nutrient, you have to test it differently. So for, for example, you can't really assess vitamin K2 in the blood accurately right now. There are some, like, surrogate markers you can use to estimate levels, but. you know, you're not getting an accurate measurement. With iodine, if you want to know long-term iodine status, you have to test it in the hair. If you do a urine test, you can see how much the patient has consumed in the past 24 hours, but that doesn't really tell you long-term status. You know, nutrients like B12, if you do serum B12, you can get a decent idea, but B12 doesn't go down until stage three and four of B12 deficiency, which is the final stage. to get a more accurate assessment of early B12 deficiency, you have to test methylmalonic acid or homocysteine. So you get the idea, it's very complicated and it's rife with problems, which is one of the reasons why I think the estimates of nutrient deficiency are even as shocking as they are, are low because let's just take B12. If a clinician runs a serum B12 test, and the B12 is, is low normal, they'll be told, hey, your B12 is normal. But if, if I was to then run homocysteine or methylmalonic acid on that patient, they're way out of range. That already tells us that that patient's not getting enough B12 and they're already experiencing significant effects of that. So, you know, it's, I think the most. Yeah, go ahead.

So, so what are the top, like, top nutrition tests and what are the ones we should be. telling everybody to get that are gonna reveal the most relevant deficiencies.

Yeah, I mean, I think just to keep it simple and even with the stuff that's available from every local doctor, vitamin D would be at the top of the list, right?

Vitamin D3, right? 'Cause a lot of doctors will measure vitamin D, not measure the right vitamin.

D. Yeah, let's measure that 25D and pretty much you should be able to get this. with, you know, every doctor's office insurance. I think serum magnesium as imperfect as it is because it's only measuring the half a percent of magnesium that exists in the, in the blood, not the night, you know, the rest of the magnesium is locked inside of the cells and tissues so it doesn't show up in the serum. But, you know, you can kind of generally assess where it is. That's really important because magnesium is a critical nutrient. Just don't rely 100% on that. If you have other symptoms of not getting enough magnesium and your serum magnesium is normal, I would still follow up on that. I run B12 and folate on every patient in part because they're so important for the health of the nervous system and the brain, and obviously we're suffering from epidemics there. with brain and nervous system conditions. And so many of the drugs, as you pointed out, Mark, interfere with B12 and folate absorption. So it's very typical for me to see low B12 and low folate in the serum. I run homocysteine.

Yeah. So you run those other tests, too. The homocysteine methionine. Yeah. Yeah.

So I run serum homocysteine. And that doesn't just tell you about B folate and B12. It tells you about your inflammatory status. So I think that's a really helpful marker. It's a risk factor for. cardiovascular disease. And then urine and serum methylmalonic acid as another way of checking B12 status. I do zinc and copper on every patient. You know, copper, excess copper is associated with dementia and Alzheimer's and a bunch of other neurodegenerative conditions. And zinc is critical for our brain function and immune function, which is particularly relevant these days. So I always want to assess zinc levels and see where that where that is. Serum cal, you know, calcium is difficult to measure in, in blood because it's so tight, it's, it's so tightly regulated in the blood that if our intake drops, the body will just pull calcium out of the bone in order to maintain a normal blood calcium level. And that's, of course, why low calcium intake in the diet leads to osteopenia and osteoporosis. So for calcium, we just, we use chronometer. which is just a way that patients record what they eat very carefully over a three-day period. And then that gives us an idea of how much calcium they're getting on a daily basis. It should be, you know, 1000 to 1200 milligrams a day, depending on, you know, age and, and, and, you know, whether they're pregnant, et cetera. And if they're not, then we need to look at other ways of getting calcium. So, that's a pretty simple approach with mostly tests that are available from any doctor and then one way of assessing a nutrient that you could do on your own with a simple app.

So that's really, really helpful. You know, in my experience, I would sort of add one thing, which is the Omega Check, which is an Omega-3 fatty acid test that I find really helpful because 90 plus percent of Americans are deficient in Omega-3s or have an excess of Omega-6s. And you can really see that rather than having an abstract conversation about it. I think just to summarize what you said, 25 hydroxy vitamin D available everywhere. Magnesium, cerium magnesium. I also would say red cell magnesium, even though maybe a little bit better, I think. And what's the optimal range? Because often the ranges are too wide and not ideal. Right. I think B12 folate, you know, methanolic acid, homocysteine for B12 folate status. I think copper zinc and copper zinc ratios are important, as you mentioned. Selenium is another thing you can easily get on a blood test, vitamin A you can get. You know, I like to measure carotenoids or beta carotene, which is sort of.

A way to tell people eat vegetables or not.

Basically, they can measure basically their flood levels. And, and so these are the kind of things that are available through a regular Quest laboratory or lab core lab that are available to your doctor. The problem is most doctors don't order them. They don't know what to do with them. They don't understand them. That's right. And, and they're not, they're not paying attention, but just because you're not looking for it doesn't mean it doesn't exist. And I think this is really one of the big challenges we're facing is how do we get people educated about what their own personal status is and how do you address that? Like you said earlier, most of the nutritional guidelines are around addressing deficiency diseases, which we found 120 years ago, and we're still basing our nutritional recommendations on that instead of what do more bodies need to optimally function, hence the word functional medicine. And Robert Heaney was a vitamin D scientist who wrote a brilliant article years ago called Long Latency Deficiency Diseases. So he said, well, if you don't have enough vitamin D in the short run, you get scurvy. And if you don't have optimal levels in the long run, you get osteoporosis or depression or muscle weakness, right? If you don't have enough folate in the short run, it's an acute deficiency, you'll get anemia. But in the long run, you might get cancer or heart disease or depression or dementia. So it's a really different way of looking at these nutrients. So what is the optimal levels? And that sort of begs the question of the testing we went back to, we talked about earlier, which I think, you know, there's a company that I've become the chief medical officer of called Function Health, which is designed to empower people with their own health data with their own health information, be able to do $15,000 worth of diagnostic testing for 500 bucks or less than 500 bucks and, and get your numbers, including a lot of these nutrient levels we're talking about, and then learn what to do about them and not just what the reference ranges are, but what are the optimal ranges like vitamin D? You say, well, if it's less than 20, that's a problem. Or some labs say less than 30, but it should be over 45 or 50 to be in the optimal range. Right.

So we really have to kind of rethink what we're doing.

Yeah.

You know, Mark, there's another issue when it comes to nutrients that I think we should talk about that I don't think gets airtime and that's nutrient synergy. So nutrients don't exist, they don't exist in isolation in the body as you well know. They play synergistic roles and you could have adequate levels of one nutrient, let's say iron, you're getting enough of it in your diet, but if you're not getting enough of the nutrients that support iron absorption and metabolism then you could still be iron deficient. So for example, copper, we know that you need copper is needed for iron to to be utilized and absorbed. And if someone's copper deficient, they could be iron deficient even if they're getting enough iron. We know magnesium is needed for the biosynthesis and transport of vitamin D. So even if you're getting enough D, if you're not getting enough magnesium, you're going to have problems there. And I mean, the list goes on and on, but the point is that nutrients operate in this synergistic relationship. So we have to make sure we're.

Getting enough of all nutrients, not just individual nutrients. yeah, it's true. I just think even one organ like thyroid, right? For the thyroid hormone to be made, you need iodine. For the T4, which is the inactive hormone, it'll be converted to the active hormone, you need selenium. For the T3, which is the active form to bind to the nuclear receptor to have its action, you need vitamin D3. So, it's like you need all these different things. They work as a team. And so, what's so crazy about modern nutrition and supplement research is they single out one nutrient that they think might be beneficial and they study it alone. And I'm like, well, if Michael Jordan was the best basketball player in the world, if he was on an NBA team by himself, he would lose every game.

It's like, that's right. So it just, you know, that's, as you well know, that's, that's an artifact of drug research.

Right.

And you want to, they want to isolate the single compound and then control all the other variables and keep them similar, but that's, that's not how functional medicine works, that's not how the body works. It's really a complex symphony of interactions all the time.

And they work literally on hundreds of different pathways and enzymes. I mean, each nutrient can have literally hundreds of different effects in the body and be involved in hundreds of different processes. So, it's important to make sure we're-.

And we're still learning about that, right? It's just crazy. I mean, I think we're just scratching the surface.

Yeah.

Understanding because it's so complex that we, have just applied our kind of reductionist, you know, framework, allopathic framework to try and understand these nutrients. And there are some researchers out there like Gregory Scrinis and others who are looking at food synergy as this complex web of interactions. And maybe even with AI and some of the new tools that we're going to have available to us, we'll be able to figure some of this stuff out. But just for listeners, you know, anyone watching or listening, the important, this is why we're so, you know, Mark and I are such big fans of getting as many nutrient needs as you can meet through food because food has those, you know, when you eat a food, it doesn't just have one nutrient. It has multiple different nutrients and often food contains the actual nutrients that support the other nutrients in that same food. That's nature's intelligence, right?

Yeah, so true. It's so true. So, a funny people ask me, well, can I take all these supplements at once? I'm like, I said, did your body know what to do? I said, listen, do you realize how many molecules are in the food you eat? How many phytochemicals? Hundreds and hundreds of vitamins, minerals, all these different kinds of compounds your body has to totally deal with. Your body is super smart and knows what to do with all of it. So let's talk about another concept here. I think there's a lot of fear sometimes about taking too much or overdosing and there are certain nutrients which you have to be careful of. and there's others that doctors might do a blood test on someone taking B12 and go, oh my God, your B12 is toxic, stop it right away. And I'm like, well, no, you really can't be B12 toxic, only if you don't take enough folic acid. And so there are certain things you have to be careful of. For example, the Inuit would know that if the foreigners, the explorers back in the day, they didn't like them because they were disrupting their culture. They would feed them polar bear liver. which had huge amounts of vitamin A in it, and they would get vitamin A poisoning and they would die. So you have to be careful of some nutrients. So tell us about the ones we have to be careful of.

That's true. So you mentioned vitamin A. I think that vitamin A is a concern at extremely high doses, but it's worth noting that having adequate levels of vitamin D and K2 really increased the toxicity threshold of vitamin A. So put another way, if you're deficient in D and K2, you're going to get toxic effects of vitamin A at a much lower dose. Whereas if you're getting enough K2 and D, you have to really, you would have to be supplementing with crazy amounts of vitamin A or you'd have to be eating polar bear liver or lots of beef liver every day for that to be a concern. Vitamin D, you can overdo it with D. I almost hesitate to even mention it because 94% of Americans don't get enough. So, we're not talking about a common problem here. I just want to emphasize that most people are not on that end of the spectrum. But, you and I have both seen people in the clinic who come in and they've been taking 50,000 IU of vitamin A a day for years. Or vitamin D. Or vitamin D. Right. And their serum level is 140. Well, that is toxic. that can increase the risk of kidney stones and heart disease, et cetera. But at the doses that most people take, let's say 5,000 IU per day, there's almost no risk of toxicity.

That's true. Most people.

You're right, Chris.

I think there's a lot of misunderstanding about what the ideal vitamin D level is. And the way we look at nutrients, we talked about this before, is that it's a bell curve, which is what's normal for the population. But if 80% of the population is low in vitamin D because we live in inside, your normal level would be 20 or 30, but that's not the actual ideal level. That might not be optimal. And the reality is that you can tolerate a lot higher dose. Even the upper range of what they call normal, like 100 on some tests or 75, is not really toxic at all. In fact, Dr. Robert Heaney was a vitamin D expert, did a study where they looked at 10,000 units a day for three months in healthy young males. and there was no harm at all from that dose, which is a lot. It's way more than I give most patients. So, you know, if you're a lifeguard, your level might be 200, you know, which is, you know, so, so I think people shouldn't worry about too much vitamin D unless you're doing stupid doses or you're not taking a brand that's reputable because sometimes the brands will say, oh, 5, 000, but it might, they.

Might have not tested the product. Yeah, it's, I have some crazy patients who tend to overdo it, so I've seen a couple cases, but I, I don't think it's a concern for most people. As we said, nine, almost 95% are deficient, so that's a far bigger problem. Calcium, I definitely have concerns about, but not from dietary calcium, but from people taking too much supplemental calcium. There are studies showing that can increase the risk of kidney stones and even heart disease, because when you take it in really large doses of the supplement, it ends up in the blood and the body doesn't really know what to do with that. It doesn't get into the bones and the teeth where you want it. It gets into the soft tissues instead. So that's a problem.

I don't know about you, Chris, but I never recommend calcium supplements. I don't. I mean, I used to because that's what I learned to do as a doctor. Yeah, like 1500 milligrams a day. But it's really not about how much calcium we're taking in. It's about how much is being absorbed about your vitamin D levels and about how it's being used. And, and in countries, for example, in Africa, where they have, like, very low vitamin D, I mean, a calcium intake is like 300 or 400 milligrams a day.

They don't have any osteoporosis because they, they have lots of other benefits that.

They have in their site.

This is a great example of nutrient synergy. Vitamin D, vitamin K2, and magnesium all support calcium regulation and help calcium get into the bones and teeth where it's needed and keep it out of the soft tissue. There's speculation, like Chris Masterjohn, our colleague, has written about this. He's speculated that if you consider nutrient synergy and someone has optimal levels of D, K2, and magnesium, the RDA for the recommended amount of calcium might be more like 500 a day instead of 1,000 or 1,200, which is what's recommended right now.

And that's total including diet.

That's including diet, yeah. So, not supplementing with that amount. Yeah, right. Iodine is one of those kind of Goldilocks ones because for most people, they can get enough iodine from diet or supplementation. But, for someone with Hashimoto's, iodine supplementation, particularly at higher doses, might be problematic, especially if they don't have enough selenium. So, that's another thing. And then iron, again, iron deficiency, way bigger problem. It affects 2 billion people around the world. Iron deficiency anemia, even in the US, it's still a big problem. But it's worth noting that hemochromatosis, which is a genetic condition that causes excess iron storage, is the most common genetic condition in people of Northern European descent. It affects 1 in 200 people. That's not a small number of people in a country with 300 million people. I do a full iron panel on everyone who comes in the clinic, and I see iron overload all the time. Dr. Do, me too.

I diagnose it so often, it's crazy. I'm like, why did nobody ever pick this up on you before?

That's right. People could have it for decades and not even know it. So yeah, I'm not a big fan of iron supplementation typically, unless there's a reason, unless we see that that patient has anemia or something like that. Even then, I'll often recommend liver or spleen, organ consuming organ meats if they're willing to do that because that can really boost iron levels. But, it's a food-based form of iron. So, I think the body is able.

To.

Regulate the absorption of it better than with iron supplements.

Yeah.

So, we've got vitamin A, vitamin D, iodine, calcium, and then there's a bunch more iron. and then we also other fat soluble vitamins. Maybe, can you get to that?

Vitamin E, alpha-tocopherol. Yeah, there's studies suggesting that long-term high dose supplementation with alpha-tocopherol, which is the more common form of vitamin E, has been associated with increased risk of prostate cancer in men and heart disease as well. Again, those are just doses that we wouldn't encounter in nature. More is not always better. We have to get out of that thought process in this country. What happened was they saw that vitamin E deficiency was correlated with a lot of problems, people not getting enough vitamin E in their diet. They figured, oh, hey, if we just jack that way up, maybe we can prevent some of these problems. But of course, the pendulum swung too far in the other direction. I don't recommend supplementation with alpha tocopherol at all. Tocotrienols are a different story. They're a new form of vitamin E that's been recently discovered. It doesn't have that long-term safety risk and they have some unique benefits and effects. And in fact, I included a tocotrienol product in my supplement line for that reason. But regular tocopherols that you find in most multivitamins and supplements, I'm not a big fan of supplementing with them either. yeah.

I want to get into the forms of nutrients in a second because, you know, I think it's a really important topic that most people don't understand, which is it's not just taking any old vitamin. It's what is the form of the vitamin? How bioavailable is it? How is it actually absorbed? Is it in a form that's actually can be broken down and used by the body? And there's so many other variables we'll get into just to kind of close that Loop on the.

What we should be careful of, I think, selenium.

Some minerals. I would say selenium.

Like selenium, you got to be careful with.

Don'T want to eat too many Brazil nuts. Yeah.

Or even, you know, some supplements have like 300 micrograms of selenium, and that's going to be too much for most people. It's definitely a Goldilocks range for that one, for sure. It's one of the more toxic minerals.

But some magnesium, for example, unless you have kidney failure, you know, it's just going to be diarrhea. It's not toxic. So it's kind of confusing. Some vitamins are bad, some minerals are bad to overdose. Others are not. Like, you can take all the you know, vitamin B vitamins you want, you're just going to pee them out. Your body's not going to, you know.

We should mention potassium. You don't want to overdo it on potassium because it plays an important role in muscle contraction, including the heart contraction and action potential and cellular communication. And so, you know, getting plenty, you know, our ancestors got up to 10,000 milligrams of potassium in their diet. And that's no problem. But if you're supplementing, you should not be taking gram level quantities of potassium, I think.

Hey everyone, it's Dr. Mark. Now something I get more and more excited about every year is personalized medicine. Now when I began practicing functional medicine over 20 years ago, it was clear to me we have to look at how unique each body is. Now with technology advancing in amazing ways, we can truly take that concept to the next level. Like one of the tools that I recently discovered that can help us all do this from home is InsideTracker. Founded in 2009 by top scientists in aging, genetics and biometric data from MIT, Tufts and Harvard, InsideTracker is a personalized health and wellness platform like no other. It's purpose built to help you live a longer, more productive life. Their cutting edge technology analyzes your blood, DNA, your lifestyle to give you highly personalized recommendations Then using the app, you can track your progress every day. 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If you're curious about getting your own health program dialed in to your unique needs, I highly recommend checking out Inside Tracker. Right now, they're offering my community 20% off at inside tracker.com/DrHyman. That's I-N-S-I-D-E-T-R-A-C-K-E-R dot com slash Dr. Hyman. That's me, Dr. Hyman. And you'll see the discount code in your cart. Now let's get back to this week's episode of the Doctor's Pharmacy. After almost 30 years of vigorously testing nutritional status on all my patients, I'm beyond shocked at the level of nutritional deficiencies. And I have a clientele that's generally well off, that understands health and nutrition, that's trying to do the right thing. I don't see a lot of people now, I used to, but don't see a lot of people now who eat junk food and fast food and processed food. I've had a few of those. I call them Dr. Hyman Virgins, where they don't know anything about health or nutrition, and I do their blood work and terrifying. Like, it's terrifying. The level of massive nutritional deficiency. I mean, this one little kid I had, I'll just. I'll just share a story. He had severe ADD. He had behavioral issues, was kicked out of kindergarten. But I also had all these other health issues. Asthma, allergies, acne, stomach aches, irritable bowel, muscle cramps, you know, anal itching. I mean, just. The list goes on and on. And he was seeing seven different doctors and tons of medication, and he. He just was a mess. And all he ate was junk food, processed food, processed meats. Never saw a vegetable in his life. and I could pretty much predict from his dietary history what he was going to be deficient in. He didn't eat fish, so he's omega-3 deficient. He didn't eat any seeds or grains or anything, so he was zinc deficient. He didn't eat anything with B vitamins in it. He was folate deficient. He was magnesium deficient because he didn't eat greens or beans or nuts or seeds. So he had all these deficiencies that were so common in the general population, but his were so magnified. So what I see typically, and this is not my opinion, this is an NHANES study, which is a large national governmental survey every year where they look at the health of population and they don't just ask questions, they actually go in and they find people, they testing, they see what their numbers look like. And based on these really robust data of tens of thousands of people, 90 plus percent of Americans, probably 99% Americans are deficient in something. And, and, and the major deficiencies about 90% are deficient or more in omega three fats, 50% magnesium, probably, you know, 20% in iron, zinc is 40%. deficient. So we've got these major deficiencies of these key nutrients that are really essential for biology. And what people don't understand about nutrition is and nutrients is that they're pleomorphic. And that means in English that they have a lot of functions. So if you take a drug, let's say a statin, it basically has one action. It blocks this enzyme that produces cholesterol. HMG-CoA reductase. And it also has some other, we call pleiotropic effects. It also actually induces something called nitric oxide synthase, which is good for producing nitric oxide, which may reduce inflammation. It also, but also has other side effects. It kind of blocks CoQ10 production because it's also the same enzyme and it may cause muscle injury. So, but there's generally few, very few pathways. Nutrients on the hand, like magnesium, has 300 different enzymes. that it regulates zinc, same thing, 200 enzymes. So. So they have multiple functions throughout multiple parts of our cellular physiology that if we don't have them, it's like our cellular machinery can't do what it's supposed to do. And this is. This was mind-blowing when I first heard about it. Drew Bruce Ames, one of the leading researchers in nutrition and science, they something, a test called out after him, the Ames test to look for cancer inducing compounds. And he's like, probably in his late 80s now, he's still around, and and he wrote an article years ago which basically mapped out that one third of our whole DNA, our entire DNA, codes for enzymes. Enzymes are basically catalysts that change one chemical to another chemical in your body to do what it's supposed to do. Well, if one third of your entire DNA codes for enzymes, that's important. So what do enzymes need to work? they need coenzymes or cofactors, which are usually vitamins and minerals, but also phytonutrients. So how does, you know, enzymes work? Well, there's a little key that goes in the enzyme, it turns it on, and that key is usually a nutrient, vitamin C, B6, folate. In other words, for example, to make tryptophan into serotonin, which is your happy mood chemical, you take the amino acid you're eating from tryptophan, which comes from food like protein, turkey, everybody knows turkey tryptophan, that has to get converted to serotonin. Well, that requires vitamin B6, there's an enzyme, or your thyroid, in order to make the thyroid that your thyroid gland makes into the active thyroid hormone T3, you have an enzyme there which actually requires selenium. So if you don't have selenium, it can't work. Or if you want to see the thyroid action on the nucleus where it actually does all its work to control your metabolism, you need vitamin D as a co-factor to help it function at the nuclear level to create the downstream effects, which is to turn on different genes and do different things. They regulate your metabolism and so many other things. So nutrients are such a critical part of our biology. And if we don't have enough of the required nutrients, our health degrades. And years ago, and I know this is a long answer to your question, but I'm on a roll here. It's all great knowledge. I love that. There's a, there's a. a scientist named Robert Heaney who recently died, who wrote an article called Long Latency Deficiency Diseases. So we all learned about vitamins. I mean, the vitamins we learned about only about 120 years ago. The term comes from vital amine. It's a thing that's needed for your health, for vitality, basically. And they were first discovered because they started refining grains in the 1800s because the grain mill came up and it was a great discovery that you could refine grains. And what happened was they took out all the nutrients that are in the husk and the fiber and the ectosperm where all the vitamins and vitamin E and everything is in there. And all they left was the starch. And so they started feeding this refined grains to chickens and the chickens all got really sick. and they started feeding it to prisoners. And the prisoners all got really sick. They got like beriberi and pellagra and all these horrible vitamin deficiency diseases. And they're terrible. They're really terrible diseases. Scurvy, obviously is something people don't know about. And these will kill you or make you demented or turn your skin into this whole raw mess just from little vitamin deficiency. And so that's what's discovery of vitamins. And they realized that these were sort of things needed in very little amounts. that had profound effects. Imagine if there was a drug that cost pennies, that had no side effects, that literally worked in days to cure illness. That would be pretty amazing. But that's what vitamins do. If you take someone who's vitamin deficient and you give them a vitamin, like vitamin C to someone who's got scurvy, it's like in a few days they're better and everything's gone. So, I mean vitamin C, you think, oh vitamin C, everybody's got vitamin C. But 10% of Americans are deficient in vitamin C at the level that would cause scurvy. It is no joke. So long story short, one, our food supply has been hybridized to breed out nutrition. It's bred for starch and maybe a little protein, but not for nutrients. It's also grown in soils that have very little organic matter that can't extract the nutrients from the soil for the plant. So there are nutrients in the soil, but the the plants need the microorganisms in the soil to actually, as symbiotic helpers, to extract the nutrients from the soil to go into the plant. So then it's in the plant, then you can eat it. But now maybe your broccoli today is 50% less nutritious than it was 50 years ago. So that's another problem. And then we have increased nutrient needs because we're under chronic stress, because we're exposed to environmental toxins. I mean, there were 80,000 new chemicals introduced into the marketplace since the 1900s. I mean, our bodies have to deal with all that stuff, and there's chemical reactions and detoxification, and they all require nutrients. And we are also under a tremendous amount of psychological stress, even in the society. And, you know, magnesium, your body wastes magnesium when you're under psychological stress. So there's so many things that are happening in our omega-3 fats. We don't get those because we don't really eat wild food anymore. Maybe some fish, but that's got mercury. So there's all these problems that happen because of our nutritional environment. And so more than ever now, people need foundational nutritional support. I believe that. And I, and I, and I say this not from a, you know, sort of a, a sort of a general opinion, but actually from really hard scientific data. And they go, oh, well, all the vitamin studies, they show that it don't, that they don't prevent heart attacks, they don't prevent cancer, they don't do this, they don't do that, or they may have side effects. And, and the truth is, the studies are just all poorly designed. I mean, it's like think about Michael Jordan, arguably the best basketball player in history. If you put him on a court by himself, he could not win a single game.

Against another team that had a full team.

Yeah, so nutrients work as a team. And if you don't have all of them, your biochemistry gets gummed up and it can actually cause worse problems. So for example, they did this large study called the Carrot Study where they gave smokers who were at high risk for lung cancer beta-carotene because it seemed like people who ate fruits and vegetables with lots of beta-carotene actually did better. But when they actually gave the beta-carotene as a supplement, what happened was there was more cancer. Now, the science was like, oh, this is terrible. Supplements don't work. I'm like, one, this is a perfect example of what Michael Pollan calls nutritionism, which is reductionism in nutrients, where you.

Basically see, oh, it's maybe this single.

Thing and we're gonna replace that. It doesn't work like that. Which is how they think about drugs. Drugs, right? So basically, the carrot study gave high dose of beta carotene. Now, if you actually understand basic biology and how antioxidants work in the system, they work as a team. So if you give one of them, the way they work is they donate an electron to some damaged tissue or free radical, like an oxidized compound in the body. So an antioxidant will actually help deal with oxidative stress or rusting in the body, but the way it does it is it donates one of its electrons, then it becomes a radical. So for example, vitamin C is a great antioxidant, but it'll donate one of its electrons and then it becomes an ascorbyl radical, which is highly dangerous. But don't worry, then you got vitamin E to help take that electron from vitamin E and give it to the vitamin C and it becomes a tocopherol radical. And then that has to be dealt with by all these systems like poik acid, and that then has to be dealt with by glutathione. So you've got a whole system if you don't have all the antioxidants and you don't have the final pathways of glutathione, you're gonna get in trouble. And so you actually create more oxidative stress and more damage if you just give a high dose of a single nutrient like that.

All to say that it's another reason why that even if we have a good idea about a cocktail that would be supplemental, this just is another reminder why the base foundation of your diet is so key because there could be co-factors and co-enzymes and other aspects that are all related to this that we can't even begin to understand. So having a really incredible diet, even if you do choose to dabble into supplements here and there to be a bonus, a supplemental to your diet, is such a key reminder.

It's key. And so, you know, I believe everybody needs a good multivitamin, fish oil, let's.

Divide this and let's go through this. Instead of the three, let's divide this into like foundational items that are there. And then let's get into really the topic of today's episode, which is kind of these bonus ones that are really being highlighted for their specific role in longevity. So take us through the supplemental foundational ones.

I mean, so, so basically everybody should be on a good multivitamin with the right forms of nutrients in the right balance. And when I say the right forms and bio available, because, for example, you can go to the drugstore and buy magnesium oxide, but it's the cheapest form of magnesium, but it's poorly absorbed. Or you could buy folic acid, but maybe your genetics don't allow you to convert it to the effective form of folic acid called methylfolate. So you need to buy methylfolate. So it's really important to know what your body needs. But a basic good multivitamin from a company that focuses on therapeutic products that mostly doctor related companies, but you can still get these products. That's a good place to start. Then fish oil, really important. And there's many different kinds of fish oil. There's, you know, you kind of worry about where it comes from. Was it distilled? Does all the, are the toxins and mercury out of it? Is it oxidized? How, what's it preserved with? What kind of animal is it from? Like, there's a whole bunch of questions, right? But, but like, there's also, also ways of processing it that preserve a lot of the benefits of fish oil, like big bold health has a product called Dutch Harbor Omega. Just transparently, we're involved with Big Pool Health. It's my mentor, Jeffrey Blaine's company. And, it's very impressive. He's basically found a process by which they extract the fish oil in Alaska from wild salmon and other fish that preserves something that is really important in fish oil called Pro-Isolv and Mediators. So, you can get EPA DHA, which is fish oil. But then also what's so amazing about eating fish and fish is that there's these compounds that have been recently discovered that are like the break on your immune system. So we have an accelerator on an immune system, break on immune system. So our immune system, they're so overactive inflammation. So these pro-resolving mediators, which have been extensively studied at Harvard, are amazing. And they're contained in this particular fish oil, Dutch Harbor Omega, because it actually processes in a way that doesn't destroy it. The third key supplement is and by the way, like I said, 90 plus percent of people are deficient Omega-3 fats.

So that's just a no-brainer. And there was a big study that came out last year showing that individuals who were at the right Omega index had an extra 3 to 5 years of their life. Yeah, no doubt.

So if you're talking about longevity, even.

Though it's foundational, like this is one of those things to really look at.

These are called essential fatty acids. That means they're essential for life. They're like a vitamin. if you don't have them, you're screwed. And they, every cell membrane in your body is made out of them. Your brain is 60% made out of them. Your skin, your hair, your nails, all your body functions, it regulates inflammation, prostaglandins. I mean, it's just really, really important. So it regulates metabolism, blood sugar. So it's really critical to have the right one. The, the next one that I think in addition to multi and fish oil is vitamin D. 80% of us are deficient or insufficient in vitamin D. It's so important. And COVID has kind of highlighted the consequence of this because when you look at the data around COVID, if you're low in vitamin D, you're 70% more likely to end up in the hospital on the ICU and die. If your vitamin D level is higher, it's actually you're 97% protected from ending up in the hospital or dying. And if you are vitamin D level is over 50, which is where I like to see it, nanograms per deciliter, there's a, there was zero deaths, zero deaths, which is better than any vaccine out there, you know, I think so. That's, and people are sort of ignoring that for the most part. But the data is very clear. So multificial vitamin D. And then if I had to add a couple others around the margins, it would be magnesium or really magnesium-rich foods and then maybe a probiotic because our guts are also messed up. So that's sort of the stack that I like. sit on? Let's talk about how we learn in our practice, the UltraWellness Center, about what people's nutritional status is. How do we figure that out?

Well, so we look at it from multiple different angles, right? First, it starts with a physical exam. What is their waist-to-hip ratio? How are they holding on to weight in their body? Then, we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they they have different spots on their nails, which could indicate zinc deficiency. We look at their diet intake. Wait, wait, wait.

The nutritional physical exam, I just want to pause because you teach that course at the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies. So we know the obvious ones, for example, if you have scurvy, you get no gum issues. If you have B vitamin deficiencies, you get little cracks in your mouth called kelosis. If you have white spots in your.

Teeth, it might be zinc deficiency. For example, bumps on the back of your arms or dry skin, we think about vitamin A a lot.

We think about zinc. And my favorite test is a vitamin D test. You know what that one is? Yes.

Tell us about that. So, if you bang on somebody's leg and they have pain, then that could be a sign that they're low in.

Vitamin D. Yes, if you take your thumb and you press right now, ready to go press right now on their shin bone. And if it's tender, then it means you're probably vitamin D deficient because it makes your bone soft. Now, I take vitamin D so my.

Bone doesn't hurt at all when I press on it.

You're pressing right now. Oh yeah, mine doesn't hurt either. Yeah, you go. I'm taking my vitamin D. I'm taking.

My vitamin D. So you can do a simple test. So there's a lot of things clinically you can figure out that are signs of nutritional deficiency. So that's the first step. And I think that's really important to look and examine because biomarkers are not perfect, which are lab tests. They can be very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. We know that magnesium, as we talked about, it's a very common deficiency, but sometimes serum magnesium and red blood cell magnesium can be normal and somebody can still be deficient in magnesium and would benefit from more magnesium, whether it's dietary or supplement wise.

Well, that's the other thing. We take a detailed history. So by actually questionnaires, you can determine what your nutritional deficiencies are. So I wrote my book, UltraMind. I literally had questionnaires in there. How do you know if you're zinc deficient, vitamin D deficient, magnesium deficient, folate.

Deficient, you know, so forth. And you can actually do these questionnaires and you're going to get a pretty sense if you're deficient or not. And then you look at their diet, too. You know, you look to see what they're eating and what they're not eating. You know, when somebody's as a vegan, you're thinking more about, okay, I've got to really look for B12, I've got to really look for issues with iron, I've got to really think about zinc and the omega-3 fats because they're more common deficiencies, you know, yeah, if you're not eating any animal products. Iodine, because you don't eat fish, right? So, there's things we have to think about depending on what their diet is like and their digestive system. So, we do a comprehensive approach and the biomarkers can be really helpful too. They're not perfect, but... Like blood tests or what other tests? Yeah, so we can look at blood, we look at urine. We do this panel called the Ion Panel, and it's this all-over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood. Building blocks of protein, yeah. Yep. And it tells us about omega levels, omega-3 levels, omega-6, six levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria, you know, steps of the Krebs cycle, which need nutrients to work properly. Like you were talking about those cofactors, the vitamins and minerals that help those reactions work so we can take our food and turn it into ATP or energy. So when we have deficiencies in certain nutrients, we'll see shifts in this panel called the organic acid testing. which, you know, that's really helpful. It's a urine test.

It's a urine test. That's really important. So what you're saying essentially is that we use a lot of different kinds of testing because your typical doctor will check your blood levels. But if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine. So each nutrient requires a very different approach depending on the nutrient. So vitamin D, yeah, you can check your blood level of vitamin D. You ought to check the right one. but it's pretty good. Yes. Right, you can check your blood levels of omega-3s pretty good, right? But you want to check in the right way.

Yes.

Some like folate or B12 or magnesium, not so much. Not so good, right? And I think, you know, you mentioned magnesium, it's a really good point. So a lot of doctors will check magnesium. Now, if it's low on a regular blood test, it means you are in big trouble. You're really low. You're really low. And then you can check red cell magnesium, which is a little bit better. But the true test is something called a magnesium loading test. Which is what?

So you give magnesium and then you collect urine for a period of time. So that magnesium, depending on the level of sufficiency that somebody has in their body, that will impact how much magnesium that spills over into their urine.

It's not a test we do very often, but you really want to know, you got to give someone a load of magnesium. If they pee it out, they're good. If they hold on to it and nothing comes out in the urine, they're pretty low.

And you were mentioning folate and B12. I see this all the time. People come in with a B12 level that their doctors did and it's normal and so then they go, okay, I don't need B12. But many times that's not really telling us about functional markers of B12 or what is sufficient for that individual person. So we'll do things like methylmalonic acid and homocysteine. They're more functional markers of the B vitamins that give us a lot more information than just a serum level of a vitamin.

So in other words, is it doing what it's supposed to do in the body? Yes. And if it's not, you're gonna see a backup of these other compounds that we don't normally test. Exactly. You know, Doctor, should you check your B12, folate, they're fine. You may not be fine. Yes. And I've seen many patients who are not fine and who have very severe deficiencies and need different types, and often you can tell if someone needs a certain type of a nutrient, looking at their genetics and their blood tests, you can tell if they need this form or that form of the nutrient. So it becomes very sophisticated in an approach to functional medicine.

I mean, I think that's a great example of where a lot of supplements out there are not great because they're not giving the right type of nutrients within the supplement. So for example, if a supplement is less expensive, they may use folic acid in the multivitamin. And folic acid, not everybody because of their genetic makeup, can utilize folic acid and use it for what the body needs folic acid for, folate for. So folic acid is a synthetic form of folate.

They may increase risk of problems. Dr.

Yes, increased risk maybe of cancer, right? So not everybody can take folate and the form of folic acid and utilize if they have a shift in this, if they have a genetic variation called the MTHFR gene, and there's others as well. And so those are things we look at as well. And when we use vitamins, we use really good quality ones, ones that are more, the body is more able to utilize like a methylfolate form. And that makes a huge difference for people.

Yeah.

And in so many aspects to actually picking the vitamin, right? It's not just the form of the nutrient, but is it is it the form that's bioavailable? Is it absorbed? What is in with it that can prevent its absorption? What exactly is it? So you can say, oh, I need magnesium. I'm just going to go to the store and get some magnesium.

It's usually making using oxide, which is really cheap magnesium. It's in most supplements, but doesn't really get absorbed very well and may not be effective.

Right.

Magnesium oxide and also magnesium citrate, they're more likely to pull water into the gut. And so they'll loosen up the stools. For some people, they need that. that's good, but it's not as well absorbed as a chelated form of magnesium, like magnesium glycinate, which is much better absorbed into the body. So depending on what you're using your magnesium for, you want to be making.

Sure you're choosing the right one. Yeah, so what's different about here at the UltraWellness Center and what we do in functional medicine is that there's a really deep understanding of the role of nutrition and nutrients in health. And what's so important about these is it's not that there's single function compounds, right? So, you know, if you take a drug, it usually hits one pathway, does one thing, right? Yeah. When you take magnesium, it affects 300 different enzymes and has many, many other functions in the body.

It's phenomenal. Magnesium is an amazing mineral and it's so good for us in so many ways. And when people are magnesium deficient, we see all sorts of issues from depression, anxiety, Muscle cramps, hypertension, asthma, restless leg syndrome, diabetes, more insulin resistance. So magnesium is-- Don't forget constipation. Oh my goodness, I forgot constipation. Headaches.

Headaches, yep. Right? It's-- Migraines.

Yeah.

Twitchy muscles.

People get twitchy eyes. Yeah. I had a lot of twitchy eyes in residency. I love magnesium.

Yeah, so magnesium. It helped my twitchy eyes. so people get treated for all these problems, right? They get treated for constipation, they get treated for... And the sort of ironic thing about magnesium is that it's used all the time in medicine as a last resort.

Right?

So when a woman comes in who's in preterm labor and their uterus is contracting like crazy, they get IV magnesium. If a woman is high blood pressure in pregnancy, they come in, they're about to have a seizure, they give them IV magnesium. Why? Because it works better than anything else. if someone's having a cardiac arrest and arrhythmia, when all the other drugs fail, they give magnesium as the last step because it helps to relax the heart muscle. So, I call it the relaxation mineral. So, anything that's twitchy, irritable or tense, whether it's anxiety, insomnia, constipation, muscle cramps, twitchy blood vessels, high blood pressure, twitchy heart, which is palpitations, twitchy emotions, which is anxiety. All these things are related to insufficient magnesium and they're treated, you know, take Xanax for anxiety, you know, take a laxative for constipation, take a migraine pill for your headache, take, you know, this or that for this or that. And it's unfortunate because it just, this.

Is such a simple solution. And we know it's a vicious cycle, right? We know that chronic stress, when we're under chronic stress, that that causes our body to excrete more magnesium in the urine so we become more deficient in magnesium. So, we have- Chronic stress, who's got that? I know, right? So, then you become a professional in magnesium. Stressless time right now. And then you get more anxious and then you use up more of your magnesium. So, we know that when we're dealing with chronic stress, we're using up our magnesium, we're excreting more magnesium and we need even more magnesium because that was.

What helps us feel calm. And so, it's- We'll go through all.

The things that actually cause us to lose magnesium.

Magnesium.

So, I mean, we. Stress. Stress is a big one.

I remember if I just interrupt, I remember one study I read of Kosovo, and they did magnesium studies, and they found that people in Kosovo, under all that war and stress, they had really huge amounts of excretion of magnesium, whereas.

People who weren't in that environment didn't. We know that people who take like proton pump inhibitors. Acid blockers.

Acid blockers. And I mean, like, protonix and prilosec. like Nexium and all those drugs?

Yeah, that decreases your magnesium absorption. So, you know, just depending on your medication, that can deplete your body of magnesium.

Diuretics, blood pressure pills, which you need.

Magnesium to control your blood pressure. You're taking a pill that causes you to lose magnesium. Right, again, that vicious cycle that we see all the time.

Yeah.

Alcohol?

Alcohol depletes your body of magnesium and all the B vitamins, so I think that's important.

Smoking? Well, nobody's into smoking.

Sugar. Yeah.

And my favorite of all of them, coffee.

Yeah.

Right, coffee causes magnesium loss. So you live an American lifestyle where you're drinking coffee, drinking alcohol, lots of stress. You have, you know, probably a pretty crappy diet.

And then you take a proton pump inhibitor.

You take an acid blocker. You take an acid blocker if you're eating a crappy diet. And then on top of that, you're.

Eating a very low magnesium diet.

So talk about how that plays a role.

You know, magnesium is in so many of our foods.

Magnesium is in our- well, not the.

Foods we actually eat. Well, yeah, but it's in our nuts and seeds, our beans and legumes, our vegetables. Greens. Greens, yep, our vegetables. And it's in whole grains like quinoa and buckwheat. So it's in a lot of our food. But when you take, for example, brown rice and you make it white rice, you deplete, about 90 plus percent of the magnesium is released or is lost. in that processing. And so, and they don't spray that back on, you know, they'll spray back on some B vitamins but not the magnesium. So when people are eating refined and processed foods, they're getting a more magnesium deficient diet. So, and sometimes people don't even realize they're getting refined and processed foods. I mean, sometimes people are like, I have a healthy diet, but they forget about that piece of toast at breakfast or the crackers at lunch that are made up of, have white flour in them and that are are more magnesium deficient. And as we get older, we can't really eat as many calories as we used to, so we're more likely to have problems over time as well.

I think the diet is so magnesium deficient. Our lifestyle is so magnesium depleting, and so we're kind of getting it from both ends. And we see this as one of the most common problems in our practice that is undiagnosed, and you know, the patients think we're geniuses because all these problems they've suffered from just go away and they're like, wow, how did you know? You know, it's not that hard. It's just good medicine and we know, I mean, this is not functional medicine, it's just medicine and it's often being missed.

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